WHAT IS COMMUNICATION? · 2017. 11. 2. · Supported Conversation for Adults with Aphasia (SCA ™): For patients/clients who “Know More Than They Can Say” People with APHASIA:

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Communicating with

Patients/Clients who

Know More Than They Can Say

Based on Supported Conversation for Adults with Aphasia (SCA)™

Presenter: Vivienne Epstein SLP, M.Sc., Reg. CASLPO

Adapted from The Aphasia Institute

WHAT IS

COMMUNICATION?

HOW DO WE

COMMUNICATE?

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COMMUNICATION INVOLVES:

Language:

TALKING/SPEAKING

LISTENING/UNDERSTANDING

WRITING READING(UNDERSTANDING)

Acquired

Communication

Disorders in Adults:

APHASIA

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Aphasia is a disorder of the

use of language;

that is in the way we

express or comprehend ideas

through words

Ref: Martha Taylor Sarno

(1994 Communication Skill Builders)

Aphasia

As a result of the language disorder of

Aphasia

the ability to have conversations is

affected.

CAUSES OF APHASIA

• Stroke

• Brain injury

• Usually involves the left side of the

brain

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PREVALENCE OF APHASIA15,000 – 20,000 STROKES PER YEAR IN

ONTARIO

40,000 to 50,000 strokes in Canada

each year.

About 300,000 Canadians are living

with the effects of stroke.

AT LEAST ONE IN THREE CLIENTS WITH A

STROKE WILL BE DIAGNOSED WITH

APHASIA

Aphasia

is most often a

chronic communication

disorder

TYPES OF APHASIA

BROCA’S APHASIA - expressive APHASIA

WERNICKE’S APHASIA - receptive APHASIA

MIXED APHASIA - combination

GLOBAL APHASIA – combination; but severe impairment

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Non-fluent

Broca’s

Expressive

Frontal

Motor

Fluent

Wernicke’s

Receptive

Posterior

Sensory

Broca’s Aphasia

�SPEAKING generally limited verbal output

- telegraphic speech

�UNDERSTANDING relatively good

�READING COMPREHENSION relatively good

�WRITING ability usually reflects speech

�Often associated with right hemiplegia

Getting the Message Out:

TALKING / SPEAKING:

With a talking / speaking difficulty:

the person will not be able to share his/her:thoughts ideas messagesquestions, through words / speech,

or may be unable to have conversations

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Getting the Message Out:

WRITING

With a writing difficulty:

the person will not be able to express his/her:thoughts/ ideas /messages/, through writing/ email

or complete forms , surveys

Wernicke’s Aphasia

SPEAKING fluent, but filled with errors – ranges from jargon to rare word substitutions

UNDERSTANDING Impaired

READING COMPREHENSION often parallels auditory comprehension/understanding

WRITING parallels speech, typically

�Less often associated with hemiplegia (mostly posterior lesions)

�Often associated with visual field cuts (hemianopsia)

Getting the Message In:

LISTENING/ UNDERSTANDING

If there is a difficulty with understanding when others speak, then that person will have difficulty with / be unable to:

follow questions / spoken directions / instructions / spoken information / and follow conversations.

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Getting the Message In::

READING Comprehension

With a difficulty with reading comprehension, the person will have difficulty with / not be able to:

read and follow handouts / forms/ written instructions/ or written informationor may be unable to enjoy the recreation of reading books/ magazines / internet

Global Aphasia

�SPEAKING: poor, markedly limited verbal output –often stereotypic utterances

�UNDERSTANDING: poor

�READING: poor

�WRITING: poor

�Gesturing: poor

�Preserved social interaction in contrast to poor language

Primary Progressive Aphasia

Perhaps a form of dementia with language

problems?

- Aphasia emerges and progresses

SPEAKING: word finding problems at onset- if

Frontal brain

- becomes GLOBAL (if they live long

enough)

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Types of Aphasia -Summary Table

Broca’s Aphasia:

– Nonfluent Speech

– Poor Repetition

– Good Comprehension

– Poor Naming

– Right-side Hemiplegia

– Few Sensory Deficits

Wernicke’s Aphasia:

– Fluent Speech

– Poor Repetition

– Poor Comprehension

– Poor Naming

– No Right-side Hemiplegia

– Some Sensory Deficits

OTHER ACQUIRED COMMUNICATION

DISORDERS IN ADULTS:

Cognitive Impairment, dementias, eg. Alzheimers

Disease

Hearing Loss

Dysarthria / slurring of speech – due to muscle

weakness or incoordination

Apraxia – disorder of motor planning (most common

with left side strokes)

APHASIA

“Imagine if the last sentence you say

tonight is the last full sentence you will say

for the rest of your life.”

Stephen Goff, person with aphasia

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Imagine if this were YOU:

You are intelligent but can’t understand what

people are saying

You know what you think, but can’t express

these thoughts

You feel that people think you are not able to

make your own decisions

No-one discusses complex issues with you

(about health, your situation, or how you feel)

Communication Problems Interfere

with Service Delivery

‘You need information from the patient/client, or you

need to know how he/she is feeling, but …’

– No one else is present, or

– Those present don’t necessarily have the answers

– As with any of us, people with aphasia often

prefer to give their own information

Good Communication Practices

Improve Health Outcomes

Talk is ‘the main ingredient’ in health care

Even the technical side of medicine depends on being

able to talk to the affected person

Roter and Hall, 1993

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People with aphasia are often not given the

opportunity for informed consent to health care

decisions

People with aphasia often do not receive

“communicatively accessible” education about their

illness/disability

(Pound et al, 2000 Beyond Aphasia)

Role Play

�Patient/Client: Health Care Professional:

�You cannot speak Your patient/client has severe aphasia

�You cannot use your He/she is very upset

right hand Find out what is wrong?

�You cannot write

1)World Health Organisation – ICF

International Classification for Functioning,

Disability and Health (2001)

Health status outside of the disabling condition (impairment)

Relationship between activity limitations and barriers (disability)

Participation and inclusion in society is a critical part of one’s health (participation restriction)

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Director General of the WHO

April 2002

Health is the ability to live life to its

full potential. For many people with

disabilities, the realization of that

ability is dependent on factors in

society.

Life Participation Approach (LPAA

Project Group, 2001)

Enhancement of life participation,

across the care continuum and beyond…

AODA

Accessibility for Ontarians with Disabilities Act, 2005

- to align with Ontario Human Rights Code

Addressing barriers of :

Information

and

Communication

• Requires accessibility standards

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When a person in a wheelchair cannot

enter a building because it does not

provide ramps or elevators……

ICF, AODA focus of the intervention: adapt

the environment/building structure(to

optimize access)

Just as a person in a wheel chair

requires ramps to get around

A person with Aphasia

needs ‘communication ramps’ in order to

communicate

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YOU,

can be trained to be the

communication ramp

Canadian Best Practice Guidelines for

Stroke Care 2013

All health care providers working with persons with

stroke across the continuum of care should be trained

about aphasia, including:

• the recognition of the impact of aphasia

• methods to support communication


Stroke Care 2013

Presence of post-stroke Aphasia is associated with:

• longer lengths of hospital stay (Gialanella &

Prometti, 2009)

• Poorer outcomes in terms of activities of daily living

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Stroke Care 2013

Aphasia has been demonstrated to have a negative

impact on:

• quality of life

• mood

• social outcomes


Stroke Care 2013

The presence of Aphasia has been associated

with:

• general decreased response to stroke

rehabilitation interventions

• increased risk for mortality


Stroke Care 2013

Treatment to improve functional communication

should include:

Supported Conversation techniques for potential

communication partners of the person with Aphasia

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Stroke Care 2013

• All information intended for patient use

should be available in Aphasia-friendly

format

Goals of SCA™ for all healthcare

professionals

Increase communicative

access to your services

Increase the efficiency and

effectiveness of your service

A supportive communication environmentwhich:

optimizes communication

and

lessens the impact of a communication disability

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Supported Conversation for Adults

with Aphasia (SCA ™):

For patients/clients who

“Know More Than They

Can Say”

People with APHASIA:

are still INTELLIGENT

KNOW what they WANT

are COMPETENT

can make their own DECISIONS

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SCA ™Supported Conversation

Techniques:

SCA ™

Techniques:

1) Acknowledge Competence

of the Person with Aphasia

Techniques to help people with Aphasia feel

they are being treated respectfully, and as an

intelligent adult

2. Communication Techniques:

- to help persons with Aphasia to

understand you better

(getting your message IN)

- to enable persons with aphasia to express themselves better

(getting their message OUT)

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SCA ™

Techniques:

The use of these Communication Techniques will,

in turn, help to reveal the often masked

competence of the Person with Aphasia

Video Observation Exercise I:

1) Does the doctor treat the patient/client respectfully as an intelligent adult/ acknowledge his competence?

2) Does the Doctor help the patient/client to reveal what is on his mind/ reveal his competence? ie get the message in, and help get the message out?

Gerry pre-training - videoclip

Pre-Training Interview

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Rating Scale

0 0.5 1 1.5 2 2.5 3 3.5 4

Very Poor Adequate Outstanding

Acknowledging Competence _______

Revealing Competence _______

� In ______

�Out ______

�Verify ______Aphasia

Institute

1) Acknowledging Competence

People with aphasia ‘know more than they can say’

Technique:

“I know you know!”

1. Acknowledge the patient/client’s frustrations and fears

2. Speak naturally (with normal loudness), using an adult tone of voice

Video clip: trips, dollar

2) Communication Techniques:

to reveal their competence

Getting your message IN

Getting his/her message OUT

Verifying / checking accuracy of the message

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Getting Your message

IN

Getting Your Message

IN

Techniques for getting Message IN

-will contribute to Getting the Message OUT

Get the message IN

Techniques:

1. Use short, simple sentences and expressive voice

2. Is your message clear?

3. Talk a little slower

4. Use gestures that the patient/client can easily

understand

Video clips: Fishing Jonny In-gestures

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More Get the message IN

Techniques:

5. Write key words/main idea e.g. ‘pain’ in large

bold print� Video clip: travel

6.Use Picture Resources eg Maps/Oxford Picture Dictionary/ Aphasia Institute pictographic materials

7. And / or Communication BookVideo clip: Family Headache

Getting his/her

message

OUT

Getting Message Out

Techniques:

Does the person have a way to tell you something?

Does the person have a way to answer you?

Does the person have a way to ask a question?

1. Ask “yes/no” questions

2. Make sure that the patient/client has a way to respond:

#1 golf #2 wife

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Getting Message Out

Techniques:

Ask fixed choice questions: Yes- No questions:

tea or coffee?” the 20 Questions game;

-start general eg: “Are you

from Canada?”

“Are you from Ontario?”

“Are you from Cambridge?”

More Getting Message Out

Techniques:

Ask the patient/client to give clues:

�Verbally; “Can you describe it / tell me more

about it?”

�With Gestures; “Can you show me?”


Techniques:

�Pointing to Objects, Pictures

eg “Can you show me?...”

- Use pictures/ maps/ calendars

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Techniques

� Pointing to your written fixed choices: word

choices/ key words / you generated

eg.

“Do you want………. ?

#1 children #2 optimist


Techniques

� Write down any important

information


Techniques:

3. Give the patient/client time to

respond

#1 no time

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VerifyingTechniques:

Have You Checked to Make Sure You have

understood?

Summarize slowly and clearly what you think the patient/client is trying to say, e.g. … “so let me make sure I understand. …”

Add gesture or written key words, if necessary.

#1 hockey

Video Observation Exercise II

Questions

1)Acknowledging competence?:

�Does the doctor treat the patient as an intelligent adult?

2) Helping the patient to reveal what is on his mind:

�Does the doctor make the message clear? (in)

�Does the doctor give the patient a way to answer or ask

questions? (out)

�Does the doctor check to make sure/ (verify) that he has

understood correctly?

Gerry #2

Gerry: post - training

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Rating Scale

0 0.5 1 1.5 2 2.5 3 3.5 4

Very Poor Adequate Outstanding

Acknowledging Competence _______

Revealing Competence _______

� In ______

�Out ______

�Verify ______Aphasia

Institute

Break

REVIEW

SCA ™Supported Conversation

Techniques:

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SCA ™

Techniques:

1) Acknowledge Competence

of the Person with Aphasia

Revealing Competence:

Through Supported Conversation techniques SCATM techniques:

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Tips:

Make sure that the message/ topic of conversation is clear!

Integrate techniques into ‘natural talk’- make techniques

‘invisible’

Make sure person feels they are part of a two way conversation

to the greatest extent possible

Expand what the person is trying to say in their brief words ; to

provide a sense of flow of a normal conversation, and to show

you understood

Complex / adult topics- simple language!

Verifying

Have You Checked to Make Sure You have

understood?

Good idea when verifying, to write down the key words

#1 hockey

General Strategies:

Eliminate / reduce distractions; eg noise

Observe your Client/ Patient:

• their facial expression

• eye gaze

• body posture

• gestures

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Hierarchy of SCA supports

1) Gesture

2) Writing

3) Pictures

4) Drawing

IMPLEMENTATION!

More Complex Role Plays

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IMPLEMENTATION

Practical Assignments

Modify your workplace? Is it Aphasia friendly?

Are all verbal instructions given to clients with aphasia

accompanied by written “key words”?

Is the written information given to clients and their families

“aphasia-friendly”?

IMPLEMENTATION

When staff members ask a client with aphasia a

question, do they make sure that he/she has a way to

respond?

Do staff have easy access to visual aids to support

communication with clients who have aphasia?

IMPLEMENTATION

Do staff carry a pad of paper and a black marker to

communicate with clients with aphasia?

Has everyone on the team had training on how to

communicate with clients with aphasia?

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IMPLEMENTATION

Does everyone on the team know the communication

techniques of:

“key words”

“written choice” communication

“written transcript”

IMPLEMENTATION

Does your Work environment have?

• Oxford Picture dictionaries

• Maps

• Aphasia Institute pictographic materials / booklets/

pictures

• Yes/No cards

• Rating scales

Resources• Maps, months, days of the week, clock

• Family members

• Rating Scale

• Aphasia Institute Resources – eg.

• ‘Talking to your doctor’, ‘Talking to your nurse’

• ‘What is aphasia?’

• Pictographic Communication Resources

• Pen, paper

• Font size, font choice, layout

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Aphasia Centres - Ontario

Aphasia Institute- Toronto

Aphasia Centre of Ottawa

Brantford and Paris Aphasia Programs

Haldimand and Norfolk Aphasia Programs

Halton Aphasia Centre

SAM Aphasia Program – Hamilton

Simcoe Aphasia Program

Niagara Aphasia Program (Fairhaven)

Western University (London)

York-Durham Aphasia Centre

Wellington Waterloo

CAPACITY ASSESSMENT FOR PEOPLE

WITH APHASIA

http://www.aphasia.ca/communication-aid-for-capacity-

evaluation-cace/

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QUESTIONS

?

For more information on SCA™ and

pictographic resources, please contact the

APHASIA INSTITUTE

73 Scarsdale Road

Toronto, ON

M3B 2R2, Canada

Tel: 416-226-3636

Fax: 416-226-3706

Email: [email protected]

www.aphasia.ca

THANK YOU!

VIVIENNE EPSTEINSPEECH-LANGUAGE PATHOLOGIST

SAINT ELIZABETH

and SAM APHASIA PROGRAM

905-972-0800 Ext 142282

[email protected]

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References/Resources

The Aphasia Institute: www.aphasia.ca

" Motivating for infrastructure change: toward a communicatively accessible,

participation -based stroke care system for those affected by aphasia" Aura

Kagan, Kathryn Le Blanc. Journal of Communication Disorders Vol 35

(2002)153-169

LPAA Project Group, Chapey, R., Duchan, J., Elman, R., Garcia, L., Kagan, A.,

and Lyon, J. Life participation approach to apahsia: A statement of values.

(originally published in the ASHA Leader, Volume, Volume 5, 2000)

National Aphasia Association (US)

Heart & Stroke Foundation of Canada: www.heartandstroke.ca

Ontario March of Dimes/York Durham Aphasia Centre

http://www.strokebestpractices.ca/index.php/stroke-

rehabilitation/rehabilitation-to-improve-communication/

http://www.aphasia.ca/communication-aid-for-capacity-evaluation-cace/

ParticiPics <[email protected]>

Documents

WHAT IS COMMUNICATION? · 2017. 11. 2. · Supported Conversation for Adults with Aphasia (SCA ™): For patients/clients who “Know More Than They Can Say” People with APHASIA: